(Philip M. Bonaparte, MD is a physician, ordained bishop and the Chief Medical Officer for Horizon NJ Health is the state’s largest managed health care company, committed to expanding access and enhancing the quality of health care to New Jersey’s publicly insured).

Q:  A dear African American friend of mine was recently diagnosed with stage 4 cervical cancer. What is her prognosis and could this have been picked up earlier?

A:  Unfortunately, African Americans have a higher rate or incidence (new onset) of cervical cancer than their white counterparts and they have a more advanced disease on diagnosis. Getting the appropriate screening at the designated time is a problem for many African Americans. If your friend had regular visits and was routinely seen by her gynecologist, this cancer could have been detected at an earlier stage. Earlier diagnosis would offer a much higher survival rate, especially if the cancer was detected and diagnosed in its earlier stages (1or 2).  Cervical cancer is the third most common cancer among women and the most common cancer among younger women. It usually affects women ages 35 to 55, but can affect women as young as 20.

Screening Tests for Cervical Cancer
Screening tests involve sampling the cells on the cervix, which is located at the lower end of the uterus. The surface of the cervix has many layers of cells. The Pap smear is a common test used to screen women for cervical pre-cancer or cancer. The traditional Pap smear (named after Dr. Papanicolaou) involves smearing the cervical cells onto a glass slide. More recently, liquid-based tests (for example, ThinPrep and SurePath) have become available; these tests place the sample of cervical cells into a vial containing a liquid preservative. In both types of test, the cells are viewed with a microscope to detect abnormalities.

Risk Factors for Cervical Cancer
Cervical cancer is a disease of sexually active women. Infection with specific high-risk strains of human papillomavirus (HPV) is central to developing cervical cancer (pathogenesis). You may have heard of the new HPV vaccine, which is now used in female adolescents and young adults up to age 23, that will reduce the risk of developing cervical cancer. Other factors that increase the risk of cervical cancer include sexual intercourse, use of tobacco (cigarettes, for example), use of birth control pills and a weakened immune system (due to human immunodeficiency virus or HIV infection).

Cervical Cancer Screening Parameters:

•  Patient age at initial screening should be at least 3 years from the onset of sexual intercourse

or at the age of 21.

• For most women, a Pap smear is recommended every one to three years.
• For women who have a past history of abnormal Pap smears or who have risk factors for cervical cancer, testing is recommended once per year.
• Women who are older than 30 years who have no risk factors, a negative Pap smear three years in a row and a negative HPV test may choose to have a Pap smear and HPV testing every three years, rather than every year.

Remember to consult with your medical doctor or healthcare professional. Encourage every woman that you know to have their Pap test and mammogram done on schedule and make sure you have yours done as well.

Regrettably, the 5-year survival rate for your friend is only 15%. This percentage means that only 15 women out 100 women with this type and stage of cancer will be alive after five years from the diagnosis.

Some web site resources:
The American Cancer Society (www.cancer.org)
National Cancer Institute (www.cancer.gov)

Disclaimer: The information contained in this column is of a general nature and cannot substitute for the advice of a medical professional. Even if a statement made about health is accurate, it may not apply to you or your symptoms. This article should not be construed as an attempt to offer or render a medical opinion or otherwise engage in the practice of medicine. Readers are strongly advised to seek the advice of a qualified medical professional.